Provider Demographics
NPI:1568702967
Name:FOSTORIA HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:FOSTORIA HOSPITAL ASSOCIATION
Other - Org Name:FOSTORIA COMMUNITY HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SR VP MANAGED CARE REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-824-7577
Mailing Address - Street 1:PO BOX 632982
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2982
Mailing Address - Country:US
Mailing Address - Phone:419-435-7734
Mailing Address - Fax:
Practice Address - Street 1:501 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1534
Practice Address - Country:US
Practice Address - Phone:419-435-7734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH284404291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36Z318Medicare Oscar/Certification
OH361318Medicare Oscar/Certification
OH362339Medicare Oscar/Certification